Implantable lead connector

ABSTRACT

An implantable lead connector configured for long term implantation and to electrically interconnect multiple medical devices and to channel electrical signals between said interconnected devices and a target organ, comprising: a first port adapted to receive a first signal suitable to stimulate a target tissue, a second port adapted to receive a second signal suitable to stimulate a target tissue, and a third port configured to connect to a target organ, wherein at least one of said first and second ports is configured to connect to a signal generator not integrated with said connector.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/254,945 filed on Apr. 17, 2014, which is a continuation of U.S.patent application Ser. No. 13/265,874 filed on Oct. 23, 2011, now U.S.Pat. No. 8,706,230, which is a National Phase of PCT Patent ApplicationNo. PCT/IB2010/051783 having International Filing Date of Apr. 23, 2010,which claims the benefit of priority of U.S. Provisional PatentApplication No. 61/202,958 filed on Apr. 23, 2009. The contents of theabove applications are all incorporated by reference as if fully setforth herein in their entirety.

FIELD AND BACKGROUND OF THE INVENTION

The present invention, in some embodiments thereof, relates to activeimplantable medical devices and, more particularly, but not exclusively,to a device and a method for electrically interconnecting multipleactive implantable medical devices

Active implantable medical devices are commonly used to sensephysiological signals from a target tissue or organ and frequently, inresponse, to deliver a therapy to the target tissue or organ in the formof electrical stimulation. Some devices are capable of both sensingphysiological signals and of delivering therapy in response topredetermined characteristics of the sensed signals. Examples of theseinclude cardiac pacemakers, implantable cardiac defibrillators (ICD),and implantable pulse generators, which deliver electrical stimulationto the heart in response to detection of heart defect symptoms such asarrhythmias, ventricular fibrillation, ventricular tachycardia, and/orcongestive heart failure.

Use of active implantable medical devices has increased dramatically inthe past few years. These include, in addition to those previouslymentioned, devices such as, for example, implantable nerve stimulators,sphincter stimulators, diaphragm stimulators, cochlear implants,implantable drug administration devices, among others. As a result,there is a tendency to see an increasing number of patients requireimplant of multiple devices to address different therapeutic needs.Generally, each device includes its own leads to sense signals and/ordeliver electrical stimulation. Furthermore, each device generally hasits own power source which includes batteries requiring periodicreplacement.

With the increasing demand for multiple devices, efforts are being madeto reduce the number of devices implanted by combining device-relatedfunctions. Such is the case, for example, with cardiac defibrillatorswhich many now include pacemaker functions. Additionally, efforts arebeing made to reduce the number of leads connected to each device andrunning through the body.

U.S. Pat. No. 5,325,870 “MULTIPLEXED DEFIBRILLATION ELECTRODE APPARATUS”relates to“A defibrillation electrode apparatus which providesdefibrillating, pacing, and sensing functions with the use of fewerconductors. Conductor requirements are minimized by solid-statemultiplexing that is accomplished at the distal end of the apparatus.”

U.S. Pat. No. 5,628,776 “IMPLANTABLE LEAD WITH WARNING SYSTEM” relatesto “A cardiac simulation system including a patient warning apparatus.The cardiac stimulator is an implantable pacemaker or defibrillator orcombination which can be programmed to automatically alter the voltageof its output stimulus, in particular, to increase the voltage of theoutput stimulus whenever a condition exists requiring patientnotification or warning. A specialized auxiliary lead with a shuntcircuit can be connected to a standard socket of a cardiac stimulatorheader and a standard lead, such as a cardiac pacemaker lead, can thenbe connected to the auxiliary lead. The auxiliary lead allows astimulation electrode to be implanted near excitable tissue in a securefashion to assure stimulation of tissue. The auxiliary lead includes anapparatus for shunting electrical current from the standard stimulationelectrode implanted in or near the patient's heart to the auxiliaryelectrode in the presence of a stimulation pulse with a voltage at orabove a preselected level.”

SUMMARY OF THE INVENTION

There is provided in accordance with an exemplary embodiment of theinvention, an implantable lead connector configured for long termimplantation and to electrically interconnect multiple medical devicesand to channel electrical signals between said interconnected devicesand a target organ, comprising:

a first port adapted to receive a first signal suitable to stimulate atarget tissue;

a second port adapted to receive a second signal suitable to stimulate atarget tissue; and

a third port configured to connect to a target organ,

wherein at least one of said first and second ports is configured toconnect to a signal generator not integrated with said connector.

In an exemplary embodiment of the invention the connector comprisesinterconnection circuitry configured to selectively and alternatelyconnect one of said first and second ports to said third port at lowimpedance and to the other port at high impedance. Optionally saidinterconnection circuitry is configured to isolate said medical devicesfrom each other. Optionally or alternatively, said interconnectioncircuitry is configured to allow one of said devices to detectstimulation signals by another of said devices, via said ports.

In an exemplary embodiment of the invention said interconnectioncircuitry comprises a switch.

In an exemplary embodiment of the invention said interconnectioncircuitry is powered by and responds to said stimulation signals.

In an exemplary embodiment of the invention said interconnectioncircuitry comprises voltage-responding impedance circuits.

In an exemplary embodiment of the invention said interconnectioncircuitry includes a logic circuitry and includes a memory for storing adevice state or a time. In an exemplary embodiment of the invention saidinterconnection circuitry is configured to generate a blanking havingduration on one of said ports in response to a signal on another of saidports.

In an exemplary embodiment of the invention said first and second portsare male connectors and said third port is a female connector.Optionally all of said connectors are standard implantable cardiacconnectors.

In an exemplary embodiment of the invention said third port isintegrated with a cardiac lead.

In an exemplary embodiment of the invention said connector is integratedwith one of said medical devices. Optionally said device is configuredto deliver contractility modulation signals in a manner synchronizedwith an ICD or pacemaker attached to said second port. Optionally oralternatively said device includes sense amplifies resistant to avoltage of at least 2 volts.

In an exemplary embodiment of the invention the third port comprises aconnection for a single lead connecting to the target organ. Optionallythe single lead is configured to transfer a physiological signal fromthe target organ to said connector. Optionally or alternatively thesingle lead is configured to transfer a stimulation signal from saidconnector to the organ.

In an exemplary embodiment of the invention the stimulation signals areabove 2 volts.

There is provided in accordance with an exemplary embodiment of theinvention, a method of electrical device interconnection for animplantable connector, comprising: selecting a first device forelectrically stimulating tissue;

selecting a second device for electrically stimulating said tissue; and

coupling said first and said second device to an electricalinterconnector. Optionally, said coupling comprises couplings aid firstdevice to an interconnector integral with said second device. Optionallyor alternatively the method comprises coupling said interconnector tosaid tissue. Optionally or alternatively coupling comprises selectivelyisolating one device from the other device.

In an exemplary embodiment of the invention coupling comprisesidentifying the operation of one device and raising an impedance to aconnection of the second device to said interconnector.

In an exemplary embodiment of the invention coupling comprisesselectively blanking one of said devices according to an operation ofthe other device.

In an exemplary embodiment of the invention coupling comprises providingat least one of said devices with circuitry capable of resisting damageform a signal generated by the other device.

In an exemplary embodiment of the invention coupling comprises conveyingphysiological signal from said tissue to one of said devices.

In an exemplary embodiment of the invention coupling comprises conveyingphysiological signal from said tissue to both of said devices.

In an exemplary embodiment of the invention coupling comprises conveyingan indication of an operation of one device to the other device via saidinterconnector. In an exemplary embodiment of the invention couplingcomprises causing one device to act as a slave device to the operationof the other device.

In an exemplary embodiment of the invention coupling comprisesprogramming at least one device with an operational parameter fordesired operation with the other device.

In an exemplary embodiment of the invention said first device is acontractility modulator and wherein said second device is a pacemaker oran ICD.

There is provided in accordance with an exemplary embodiment of theinvention, a method of using two electrically interconnected medicalelectrical stimulators, comprising programming at least one of saidstimulators with an operational parameter suitable for co-operation withthe other stimulator. Optionally said parameter comprises a blankingtime. Optionally or alternatively said parameter comprises a delaygreater than one second after operation of the other device.

There is provided in accordance with an exemplary embodiment of theinvention, an electrical stimulator system, comprising:

a first implantable electrical stimulator;

a second implantable electrical stimulator separate and includingseparate implantable housing form said first stimulator; and

implantable interconnection circuitry which interconnects saidstimulators and a target tissue. Optionally, said circuitry isintegrated with said first stimulator. Optionally or alternatively, saidfirst stimulator is a contractility modulator and wherein said secondstimulator is an ICD or a pacemaker. Optionally or alternatively saidsystem comprises only a single lead attached to said target tissue.Optionally or alternatively, said interconnection circuitry selectivelyand alternately isolates one stimulator from the other.

Unless otherwise defined, all technical and/or scientific terms usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which the invention pertains. Although methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of embodiments of the invention, exemplarymethods and/or materials are described below. In case of conflict, thepatent specification, including definitions, will control. In addition,the materials, methods, and examples are illustrative only and are notintended to be necessarily limiting.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

Some embodiments of the invention are herein described, by way ofexample only, with reference to the accompanying drawings. With specificreference now to the drawings in detail, it is stressed that theparticulars shown are by way of example and for purposes of illustrativediscussion of embodiments of the invention. In this regard, thedescription taken with the drawings makes apparent to those skilled inthe art how embodiments of the invention may be practiced.

In the drawings:

FIG. 1 schematically illustrates an exemplary implantable lead connectorwith each port including serially connected impedance, according to someembodiments of the present invention;

FIG. 2 schematically illustrates an exemplary lead connector with eachport including a voltage-dependent serially connected impedance,according to some embodiments of the present invention;

FIG. 3 schematically illustrates an exemplary lead connector with eachport including a voltage-dependent serially connected impedance and avoltage-dependent parallel connected impedance, according to someembodiments of the present invention;

FIG. 4 schematically illustrates an exemplary configuration forinterconnecting an IPG with a DDD-ICD using an implantable leadconnector, according to some embodiments of the present invention;

FIG. 5 schematically illustrates an exemplary configuration forinterconnecting an IPG with a DDD-ICD using an implantable leadconnector, according to some embodiments of the present invention;

FIG. 6 schematically illustrates an exemplary configuration forinterconnecting an IPG with a DDD-ICD using an implantable leadconnector, according to some embodiments of the present invention;

FIG. 7 schematically illustrates an exemplary configuration forinterconnecting an IPG with a ICD-VVI using an implantable leadconnector, according to some embodiments of the present invention;

FIG. 8 schematically illustrates an exemplary configuration forinterconnecting an IPG with a ICD-VVI using an implantable leadconnector, according to some embodiments of the present invention;

FIG. 9 illustrates a flow chart of a method of interconnecting an IPGwith a DDD-ICD using an implantable lead connector, according to someembodiments of the present invention;

FIG. 10 illustrates a flow chart of a method of operation of animplantable lead connector interconnecting an IPG and an ICD including apacemaker;

FIGS. 11A-11C schematically illustrate a combined IPG/ICD deviceincluding an attachable implantable lead connector, according to someembodiments of the present invention; and

FIG. 12 shows an exemplary timing diagram, according to some embodimentsof the present invention.

DESCRIPTION OF EMBODIMENTS OF THE INVENTION

The present invention, in some embodiments thereof, relates to activeimplantable medical devices and, more particularly, but not exclusively,to a device and a method for electrically interconnecting multipleactive implantable medical devices.

The present invention, in some embodiments thereof, relates to activeimplantable medical devices and, more particularly, but not exclusively,to a device and a method for electrically interconnecting multipleactive implantable medical devices.

An aspect of some embodiments of the present invention relates to animplantable lead connector adapted to connect leads from multiple activeimplantable medical devices to a single shared (or multiple shared,e.g., 2, 3, 4 or more) implantable lead attachable to a target tissue ororgan. Optionally, sensing of a physiological signal in the targettissue or organ is done through the single lead. Optionally, stimulationof the target tissue or organ is done by sending a stimulation signalthrough the single lead. Additionally or alternatively, use of theconnector allows the multiple active implantable devices to share asingle lead to sense signals from and/or deliver therapy to the targettissue or organ. Optionally, a number of devices which may be connectedthrough the connector to the single lead are at least 2 devices, atleast 3 devices, at least 4 devices or at least 5 devices. In someembodiments, the adapter is not implanted, but, for example, is attachedto the skin and/or remains outside the body.

In an exemplary embodiment of the invention the lead connector is usedto update a functionality of an implanted device, for example, withadded functionality provided by the connector or by an implanted device.Optionally the functionality is an improvement of the implanted device,for example, advanced pacing logic. Optionally or alternatively, theimprovement is an additional function, such as ICD for a pacemaker. Inan exemplary embodiment of the invention the lead connector protects thedevices from each other (e.g., by adding blanking periods) and/orsynchronizes the functions of the devices.

While in some embodiments one device is unaware of the other device.Optionally at least one device is programmed to take into account theexistence of the other device, for example, by including blanking periodwhen the other device is active. Optionally or alternatively one devicereads the operation of the other device, for example, by sensing pacingcommands thereof, for purposes such as, for example, timing or inferringof logical state of the heart or other device. Optionally after theoperating of one device, the other device delays operation, for example,to allow tissue to recover or based on an estimating of tissue state dueto the other device operation (e.g. arrhythmia), for example, for 1second (or one or 2-5 beats), 5 seconds, 10 seconds, a minute, 5minutes, one hour, a day or greater or intermediate durations.

In an exemplary embodiment of the invention only a single lead isattached to the heart. Optionally, however, additional leads, whichoptionally bypass the connector, are used. Optionally the connector isused to provide blanking or current protection also for unshared leads.In one example, different devices have different sensor leads (e.g.,blood pressure sensor and flow sensor). In another example, sensor leadsare also shared.

In an exemplary embodiment of the invention the connector comprises alead optionally integrated with a small capsule, which small capsule isconfigured to attach to an ICD and a different medical device.Optionally the lead has a screw type electrode (or other tissueattaching electrode) and sensing electrode at its tip, suitable for ICD.Optionally the capsule includes a cable suitable for connecting to anICD and a cable suitable to connect to a CCM or other device. Optionallythe capsule has a volume of less than 20 cubic cm, 10 cubic cm, 5 cubiccm or 2 cubic centimeters Optionally the capsule is thinner than 5 mm, 3mm, 2 mm. Optionally the CCM (or other device) acts as a slave devicewhich modulates, modifies, adds signals and/or modifies its behavioraccording to the ICD behavior. Optionally the CCM (or other device) hassense amplifiers configured to resist damage when hit with adefibrillation and/or pacing voltage.

Optionally the connector includes circuitry, for example, powered bypacing pulses or by an internal battery, which applies a logic, such asblanking to ports thereof.

In another embodiment, a CCM device is configured to include an input toreceive an ICD lead. Optionally the connector logic as described hereinis included in the CCM or other device. Optionally the CCM is providedwith leads suitable for both CCM and ICD. Optionally the lead includesone or two defibrillation electrodes and two electrodes (e.g., ring andscrew-in) used for pacing and for supplying a CCM signal. Alternatively,at least one extra CCM lead is provided.

Connection of a single lead to two or more active implantable deviceswhere at least one of them is capable of stimulating a target tissue ororgan generally cannot be done with a passive signal splitter. Onereason is that the stimulation signal delivered by one of the devicesmay cause inappropriate functioning or even damage to sensing or othercircuitry in the other devices. In some cases, the impedance of theother devices may be altered which may cause impedance mismatchingbetween the devices. Furthermore, the stimulation signal delivered bythe device may be shunted by the protection circuitry of the otherdevices instead of being delivered to the target tissue or organ, orotherwise be provided to target tissue with wrong parameters.

However, in some embodiments of the invention, a passive splitter isused, or, in some cases, only one port is protected. Optionally a deviceconnected to an unprotected port is designed to include sense amplifiersand/or other circuitry resistant to stimulation voltage, for example, 1volt, 2 volts, 4 volts, 7 volts, 10 volts, 50 volts or intermediate orlarger voltages, for example, as may be provided by pacing,contractility modulation and/or defibrillation.

In some exemplary embodiments, the active implantable medical devicesmay include cardiac pacemakers, defibrillators, pacing defibrillator(DDD-IDC, dual chamber; ICD-VVI, single pacing), implantable pulsegenerators (IPG) for CCM (Cardiac Contractility Modulation), and devicesfor cardiac resynchronization such as DDD-CRT, CRT-D, and CRT.Optionally, the active medical devices include IPG for blood pressurecontrol, implantable nerve stimulators, sphincter stimulators, diaphragmstimulators, cochlear implants, and implantable drug administrationdevices.

In some exemplary embodiments, the implantable lead connector is furtheradapted to connect leads from one or more external active medicaldevices to the single implantable lead leading to the target tissue ororgan. Optionally, the leads from the external active medical devicesare inserted into a patient's body through an appropriate transcutaneousport. Optionally, the connector is adapted to connect leads from one ormore external active medical devices and from one or more activeimplantable medical devices to the single implantable lead leading tothe target tissue or organ. Additionally or alternatively, the externalactive medical devices include medical devices adapted to performsimilar functions as those performed by the implantable active medicaldevices and are located externally to a patient's body. Optionally, theexternal active medical devices are temporarily attached to theconnector.

In some exemplary embodiments, an existing implanted device may beconnected to the connector with a new devices being implanted forsharing a single lead. For example, an implanted pacemaker may beconnected to the connector together with a new IPG. Optionally, twoimplanted devices may be connected to the connector for sharing a singlelead.

In some exemplary embodiments, the connector includes multiple deviceports to which the leads from the multiple devices are connected.Optionally, a portion of the device ports each include a variableimpedance element for varying an impedance of the port. Optionally,varying an impedance of the device port allows for control of a currentflow to and/or from the device attached to the port. Optionally, theconnector acts as a “switch” switching signal flow between attacheddevices through the multiple device ports to and from the target tissueor organ. Optionally, a high impedance device port limits flow of thestimulation signal from the connector to the attached device,essentially switching “off” the device. Optionally, the high impedanceis greater than or equal to 50 kOhms, for example, 60 kOhms, 80 kOhms,100 kOhms, 150 kOhms, 200 kOhms or more. Optionally, a low impedanceport allows signal flow through the port to and from the device,essentially switching “on” the device. Additionally or alternatively, alow impedance device port allows flow of the stimulation signalgenerated by an attached device through the connector to the targettissue or organ. Additionally or alternatively, the low impedance deviceport allows flow of the physiological signal from the target tissue ororgan through the connector to the attached medical device. Optionally,the serial impedance during sensing (physiological signal) is less thanor equal to 100 kOhms, for example, 80 kOhms, 60 kOhms, 40 kOhms, 20kOhms, less than 20 kOhms. Optionally, the shunt impedance is lower than50 Ohms, for example, 40 Ohms, 30 Ohms, 20 Ohms, 10 Ohms or less.

In some exemplary embodiments, the connector includes a target port towhich the single implantable lead is attached. Optionally, the multipledevice ports are parallely connected to one another and serially to thetarget port (for example, schematically in a Y-type or T-type circuitconfiguration). Optionally, the variable impedance element in the deviceport is serially connected between the attached device and the targetport (to the single lead leading to the target tissue or organ).

In some exemplary embodiments, the variable impedance elements in thedevice ports are current dependent. Optionally, a current limitingcircuit wherein the impedances of the ports vary as a function of thecurrent flowing through the circuit is used. Such a current limitingcircuit may be implemented using transistors, for example field effecttransistors, between two or more device ports together. An increase incurrent on one side of the circuit will cut off the other side of thecircuit, so that stimulation signal flowing in through one device portwill cut off the other device port. Optionally, the target port isconnected to the circuit so that the stimulation signal flows throughthe single lead to the target tissue or organ.

In some embodiments, the variable impedance elements in the device portsare voltage dependent. Optionally, the impedance of a first device portis dependent on a voltage drop across the variable impedance element ina parallely connected second device port. Optionally, a low voltage dropacross the impedance element results in a low impedance at the firstdevice port (low impedance port). Additionally or alternatively, arelatively high voltage drop across the impedance element, for exampledue to a relatively high current of the stimulation signal, causes anincrease in the impedance of the first device port (high impedanceport). Optionally, the variable impedance element includes avoltage-dependent impedance element connected in parallel between eachdevice and the lead.

In some exemplary embodiments, a front-end circuitry of a deviceconnected to a high impedance port is protected from the stimulationcurrent. Optionally, a sensing channel in the device is substantiallyblanked by the high impedance, allowing a relatively fast recovery fromstimulation current artifacts. Additionally or alternatively, theincrease in impedance in the port substantially prevents the stimulationsignal from being shunted by a protection circuitry in the device. Asnoted herein, in some embodiments blanking is provided by the device andin others by the connector.

In some exemplary embodiments, the connector connects a first device toa high impedance port, switching off the port, when a second devicegenerates the stimulation signal (the second device is connected to alow impedance port). Optionally, the stimulation signal is routedthrough the connector to the single lead, bypassing the high impedanceport. Optionally, the stimulation signal is generated responsive to aphysiological signal. Optionally, the device ports are switched on atlow impedance while the physiological signal from the target tissue ororgan is being sensed through the single lead. Additionally oralternatively, the physiological signal is routed through the singlelead and through the connector to each device. Optionally, the connectoris configured to route the physiological signal to either the first orsecond device by adjusting the impedances at anyone of, or both, ports.Optionally, the connector is configured to route the stimulation signalfrom either the first or second device by adjusting the impedances atanyone of, or both, ports.

In some exemplary embodiments, the connector is configured to connectmultiple active implantable devices to a plurality of single leads forsensing and/or stimulating different target tissues in a same organ. Forexample, in the heart, a first single lead may be attached to theseptum, a second single lead may be attached to the right atrium, and athird single lead may be attached to the right ventricular. Optionally,the plurality of single leads is used for sensing and/or stimulatingdifferent target organs (or tissues in different organs). For example,one single lead may be attached to the brain while a single lead may beattached to the spinal cord. Optionally, two or more connectors may beconnected together for increasing a number of single leads which can beattached to different tissues and/or organs. Optionally, a greaternumber of devices can be attached. Optionally, the connectors areconnected in series and/or in parallel. Additionally or alternatively, aserial connection of the connectors may allow override of one connectorover the decision of the other. Optionally, for unidirectional currentflow, a parallel flow of the connectors will allow current flow in aspecific direction based on the control of each connector. Optionally,one of the isolation circuits which isolate one device from the otherdevice may include a diode or other circuit which prevents backflow.

In some exemplary embodiments, stimulation signals are sequentiallygenerated by each device, the impedances at the ports varied accordinglyin the connector (low impedance at the port connected to devicegenerating the stimulation signal and high impedance at the portconnected to the second device, and alternating respectively as eachdevice generates a stimulation signal). Optionally, a plurality ofstimulation signals is generated by a same device. Optionally, the portimpedances are varied according to any order in which the devicesgenerate the stimulation signal. Appropriate circuitry may be includedin the connector for synchronizing with the devices. Optionally, thecircuitry can emulate a logic of one or both devices enabling theconnector (or other device) to anticipate the generated stimulationsignal and/or to determine when to apply blanking on sensing and/orstimulation.

In some embodiments, the connector includes a controller and associatedcircuitry for varying the impedances at the ports. Optionally, thecontroller varies the impedance in one or more ports according toparameters associated with the device connected to the port. Forexample, the impedance of the port may be adjusted according to the typeof medical device connected, model of the device, a manufacturer of thedevice, a power rating of the device, a stimulation current of thedevice, and an input impedance of the device, among others. Optionally,the controller varies the impedance in one or more ports according to anactivation state of the devices; pacing, sensing, stimulating, and thelike. Optionally, adjusting the impedance in a port according to theconnected device enhances blanking. Additionally or alternatively, thecontroller generates signals simulating the physiological signal tocause the devices to generate a stimulation signal, for example to forcea defibrillation. Additionally or alternatively, information as to theparameters associated with the connected device is received through thedevice leads connected to the ports. Optionally, a dedicated data lineis used to input the information to the controller. Optionally, thededicated data line to the connector can serve as a “reader” which talksto the connected devices. Optionally, the information is input into thecontroller when the device is initially connected by a physician.Additionally or alternatively, the information is preprogrammed into thecontroller. Optionally, the information is input by the physicianthrough a wireless connection. Optionally, the controller enables theconnector to be used by the connected devices as an add-on logic modulefor adding to, substituting and or replacing functions in the devices.Additionally or alternatively, the connector can block switch off onedevice and listen to the second device, switching on the first devicewhen required. Optionally, the connector can listen to the single leadand switch on the first device when required. Optionally, the connectorcan allow the first device to listen to the second device.

In some exemplary embodiments, the connector includes passive electroniccomponents such as, for example, resistors, capacitors, and coils.Optionally, the connector includes semiconductor devices such as, forexample, transistors and diodes.

In some exemplary embodiments, the connector allows for power to beshared between attached medical devices. Optionally, a connected deviceis powered by another connected device. Optionally, a connected deviceis powered by the connector. Optionally, powering multiple connecteddevices from a single device (or the connector) substantially allows fordecreasing a size of the connected devices. Optionally, powering from asingle device substantially eliminates a need for periodic replacementof a battery in the other devices (only one device or the connectorneeds to have batteries changed).

In some exemplary embodiments, the connector includes a power supply forpowering included electronics. Optionally, the power supply suppliespower to the connected medical devices. Optionally, the power supplyincludes a battery. Optionally, power is supplied from one or more ofthe attached implantable medical devices. Optionally, a power harvestercircuit (e.g., harvesting from the body, from an external powertransmitter and/or the stimulation signals) is included for charging thebattery and/or a power-storage element. In an exemplary embodiment ofthe invention the start of a stimulation signal provides sufficientpower to activate any electronics which further determine the logic ofthe connector. Optionally the two input ports are normally at a highimpedance at least part of the time and when power is detected at oneport, that power is used for logic which lowers the impedance at thatport. Optionally if power is detected at both ports, one port is definedas a master or possibly the logic is set so no port is opened.

In some exemplary embodiments, the connector includes a housing madefrom a biocompatible material such as, for example, a silicon rubbercasing. Optionally, the housing includes a disk shape. Optionally, theconnector is partly flexible. Additionally or alternatively, theconnector can be molded to a shape of one of the devices for physicallyfitting the connector against the device. Optionally, the connector ispreshaped to fit against the device. Optionally, the connector isrigidly shaped. Optionally, the silicon encases the included electronicsand connector blocks. Additionally or alternatively, the electronics ishermetically sealed in metallic or ceramic materials. Optionally, theelectronics is coated with polymeric, glass, or ceramic layers forprotection from environmental stresses such as, for example, mechanicalstresses, exposure to liquids and the like.

In some exemplary embodiments, the connector includes a greater numberof ports than are shared between connected devices. Optionally, severalof the ports are configured for passing leads through the connector, forexample, from the device through the connector to a target tissue ororgan. These ports do not include varying impedances.

In some exemplary embodiments, the connector is included in one of theimplantable medical devices. Optionally, the connector shares theresources of the medical device, such as, for example the device'scontroller, memory, and other circuitry. Optionally, the connector canbe removably attached to the device and share the resources of thedevice. Optionally, the connector shares its resources with the device.Additionally or alternatively, the connector can serve as an interfaceto physically attach two devices. Optionally, the connector shares theresources of one or both of the devices.

Following is described an exemplary application of an IPG and an ICDconnected to a connector so as to enable the devices to share leads andreduce a number of leads attached to a target tissue or organ, accordingto some exemplary embodiments.

The connector interconnects an IPG for CCM therapy such as, for example,the OPTIMIZER III IPG developed by Impulse Dynamics Ltd, Israel withdual-chamber pacing ICD (DDD-ICD). Optionally, the IPG is connected to asingle-chamber pacing ICD (ICD-VVI). In a typical configuration withoutuse of the connector, 5 leads are delivered intravenously to the heart.These include:

a) ICD's Right-Atrial lead;

b) ICD's Right-Ventricular lead (which includes a defibrillation shockelectrode);

c) OPTIMIZER III's Right-Atrial (RA) lead;

d) OPTIMIZER III's Right-Ventricular (RV) lead; and

e) OPTIMIZER III's Right-Ventricular-Septum (LS) lead.

In some exemplary embodiments, leads are shared between the IPG and theICD through the connector, reducing a number of cardiac leads deliveredintravenously into the heart. Optionally, a current carrying capacity ofthe leads is up to 50 mA or more, for example, up to 10 mA, up to 20 mA,up to 30 mA, up to 40 mA or intermediate values. Optionally, a number ofleads is determined by the impedance of the leads. Optionally, commonleads from the IPG and the ICD connect to the connector, and from therea single cardiac lead goes to the heart. Optionally, the leadsconnecting the devices to the connector include Bipolar IS-1 to IS-1cables. Optionally, the leads connecting the devices to the connectorare bundled.

In some embodiments, two leads are shared between the IPG and the ICDthrough the connector; the right atrial lead and the right ventricularlead. Optionally, these leads are connected through the connector to theheart. Optionally, the right ventricular septum lead is connecteddirectly from the IPG to the heart. Additionally or alternatively, onlythree leads are inserted in the heart (as compared to five leads withoutthe connector). Optionally, one lead is shared and three leads enter theheart. Additionally or alternatively, the IPG is activated by a singlelead. Optionally, a left ventricle lead suitable for CCM signal andpacing is shared with an ICD through the connector. Optionally, the leftventricle lead is epicardial. Optionally, the IPG includes the connector(built-in) and connects to the ICD by means of a DF-4 standardtetrapolar in-line connector. Optionally, the controller in the IPGcontrols the varying of the port impedances in the connector.

In some exemplary embodiments, the IPG actively blanks the ICD sensingfor the period of CCM delivery. Optionally, ICD sensing parametersrequire minimum, if any, setting. Optionally, the IPG uses theinformation related to pacing of the RA and/or RV to change mode todifferent set of CCM parameters. Additionally or alternatively, the IPGuses the information to change different windows setting. Optionally,the IPG uses information related to shock delivery such as, for example,using a sensing coil mounted on the lead, if a clear artifact is sensedon the other leads, to inhibit CCM or other treatment for a certain timeperiod. Optionally such sensing is used instead of or in addition to aconnector.

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not necessarily limited in itsapplication to the details of construction and the arrangement of thecomponents and/or methods set forth in the following description and/orillustrated in the drawings. The invention is capable of otherembodiments or of being practiced or carried out in various ways.

Referring now to the drawings, FIG. 1 schematically illustrates anexemplary implantable lead connector 100 including a variable impedanceelement 102 in device port 103, and a variable impedance element 104 indevice port 105, according to some embodiments of the present invention.Optionally, connector 100 is adapted to vary an impedance of impedanceelement 102 and/or impedance element 104 for routing a current flowthrough the connector between active implantable medical devices 108and/or 106 and a target organ 116. Optionally, connector 100corroborates that current flow is according to planned parameters.Optionally, connector 100 corroborates lead quality for sensing byimpedance measurements of the lead. Optionally, the impedance ofimpedance element 102 and/or impedance element 104 varies as a functionof the current flowing through the impedance elements. Optionally,impedance elements 102 and 104 include a current limiting circuit.

In some exemplary embodiments, connector 100 includes three ports,device port 103 and device port 105 to each of which a medical device isconnected, and target port 107 to which single lead 114 is connected.Optionally, device port 103, device port 105, and target port 107 areconnected in a T-type circuit configuration with the device portsparallel to one another. Optionally, connected to device port 103through a cable 112 is medical device 108. Optionally, connected todevice port 105 through a cable 110 is medical device 106. Optionally,medical devices 106 and 108 are a same active implantable medicaldevice. Optionally, medical devices 106 and 108 are different types ofactive implantable medical devices. Connected to target port 107 throughlead 114 is target organ 116. Optionally, target organ 116 is a heart.

In some exemplary embodiments, variable impedance element 102 in deviceport 103 is serially connected through lead 112 to medical device 108 onone side, and on the other side through lead 114 to target organ 116.Optionally, variable impedance element 104 in device port 105 isserially connected through lead 110 to medical device 106 on one side,and on the other side through lead 114 to target organ 116.

In some exemplary embodiments, lead 114 is adapted to sense aphysiological signal in target organ 116 and to transfer the signal toconnector 100. Optionally, lead 114 includes a single lead. Optionally,lead 114 is adapted to transfer a stimulation signal from connector 100to target organ 116. Optionally, lead 114 includes a plurality of leads,for example, two single leads attached to different tissues which are toreceive a similar stimulation signal. Optionally, connector 100 isconfigured to switch between the two single leads for sensing andstimulating two different tissues at different times. Optionally,connector 100 is configured to stimulate the two different tissues atthe same time.

In some exemplary embodiments, a mode of operation of connector 100 isas follows:

Lead 114 senses a physiological signal in target organ 116 and transfersthe signal to connector 100. The signal flows across impedances 102 and104 to medical devices 108 and 106, respectively. Optionally, impedances102 and 104 include low impedances. Devices 108 and 106 each receive thesignal and optionally based on an analysis of the signal according topredetermined criteria, one of the devices will generate a stimulationsignal. Assuming for exemplary purposes that device 108 generates thestimulation signal, impedance 102 remains low while impedance 104 goeshigh. Optionally, the impedance of impedance 102 may increase somewhatbut remains sufficiently low so as to not interfere with the stimulationsignal. The stimulation signal then flows from device 106 through lead114 to target organ 116. Flow of stimulation signal through impedance104 to medical device 106 is substantially prevented by the highimpedance. Optionally, front-end circuitry in medical device 106 isprotected from possible damage by the stimulation signal. Optionally,possible shunting of the stimulation signal by medical device 106 isprevented, allowing the stimulation signal to reach target organ 116through lead 114.

Reference is now made to FIG. 2 which schematically illustrates anexemplary implantable lead connector 200 including a variable impedanceelement 202 in device port 203, and a variable impedance element 204 indevice port 205, according to some embodiments of the present invention.In an exemplary embodiment of the invention, connector 200 is adapted tovary an impedance of impedance 202 and/or impedance 204 for routing acurrent flow through the connector between active implantable medicaldevices 208 and/or 206 and a target organ 216. Optionally, connector 200corroborates that current flow is according to planned parameters.Optionally, connector 200 corroborates lead quality for sensing byimpedance measurements of the lead. Optionally, medical devices 208 and206, and target organ 216, are similar to that shown in FIG. 1 at 108,106, and 116, respectively. Optionally, impedance element 202 andimpedance element 204 include voltage-dependent impedances.

In some exemplary embodiments, connector 200 includes three ports,device port 203 and device port 205 to each of which a medical device isconnected, and target port 207 to which single lead 214 is connected.Optionally, device port 203, device port 205, and target port 207 areconnected in a T-type circuit configuration with the device portsparallel to one another. Optionally, connected to device port 203through a cable 212 is medical device 208. Optionally, connected todevice port 205 through a cable 210 is medical device 206. Connected totarget port 207 through lead 214 is target organ 216.

In some exemplary embodiments, variable impedance element 202 in deviceport 203 is serially connected through lead 212 to medical device 208 onone side, and on the other side through lead 214 to target organ 216.Optionally, variable impedance element 204 in device port 205 isserially connected through lead 210 to medical device 206 on one side,and on the other side through lead 214 to target organ 216. Optionally,cable 212, cable 210, and lead 214 is similar to that shown in FIG. 1 at112, 110, and 114, respectively.

In some exemplary embodiments, the impedance of impedance element 202goes high when a voltage drop across impedance element 204 due to astimulation signal increases, while the impedance of impedance element204 is low. Optionally, the impedance of impedance element 204 goes highwhen a voltage drop across impedance element 202 due to the stimulationsignal increases, while the impedance of impedance 202 is low.

In some exemplary embodiments, a mode of operation of connector 200 issimilar to that of connector 100 with a difference, as previouslymentioned, that one impedance goes high when the voltage drop increasesacross the second impedance due to the stimulation signal; the secondimpedance remaining low (may increase somewhat but remains sufficientlylow so as to not interfere with the stimulation signal).

Reference is now made to FIG. 3 which schematically illustrates anexemplary implantable lead connector 300 including a voltage-dependentserially connected impedance element 302 and a voltage-dependentparallel connected impedance element 303 in device port 313, and avoltage-dependent serially connected impedance element 304 and avoltage-dependent parallel connected impedance element 305 in deviceport 315, according to some embodiments of the present invention.Increasing the impedance of an already high impedance port serves toprovide added protection to front end circuitry in the device from thestimulation current. Additionally, blanking of the sensing channel issubstantially enhanced by the high impedance, allowing very fastrecovery from stimulation current artifacts. Furthermore, the increasein impedance in the port substantially prevents the stimulation signalfrom being shunted by the protection circuitry in the device.

In some exemplary embodiments, connector 300 is adapted to vary animpedance of impedance elements 302 and 303, and/or impedance elements304 and 305, for routing a current flow through the connector betweenactive implantable medical devices 308 and/or 306 and a target organ316. Optionally, connector 300 corroborates that current flow isaccording to planned parameters. Optionally, connector 300 corroborateslead quality for sensing by impedance measurements of the lead.Optionally, medical devices 308 and 306, and target organ 316, aresimilar to that shown in FIG. 2 at 208, 206, and 216, respectively.

In some exemplary embodiments, connector 300 includes three ports,device port 313 and device port 315 to each of which a medical device isconnected, and target port 317 to which single lead 314 is connected.Optionally, device port 313, device port 315, and target port 317 areconnected in a T-type circuit configuration with the device portsparallel to one another. Optionally, connected to device port 313through a cable 312 is medical device 308. Optionally, connected todevice port 315 through a cable 310 is medical device 306. Connected totarget port 317 through lead 314 is target organ 316.

In some exemplary embodiments, the impedances of impedance elements 302and 303 go high when a voltage drop across impedance elements 304 and305 due to stimulation signal increases, while the impedance ofimpedance elements 304 is low and 305 is high. Optionally, the impedanceof impedance elements 304 and 305 go high when a voltage drop acrossimpedance elements 302 and 303 due to the stimulation signal increases,while the impedance of impedance elements 302 is low and 303 is high. Alow series impedance element and a high parallel impedance element inthe port connected to the medical device generating the stimulationsignal maintains the port switched “on”. A high series impedance elementand a high parallel impedance element in the port maintains the portswitched “off”. A low parallel impedance element substantially shuntsthe port.

In some exemplary embodiments, a mode of operation of connector 300 issimilar to that of connector 200 with a difference that the parallelimpedances provide each medical device with additional protection fromthe stimulation signal generated by the other device. Optionally, arecovery of sensing function in the protected medical devices isenhanced.

Reference is now made to FIG. 4 which schematically illustrates anexemplary configuration for interconnecting an IPG 408 with a DDD-ICD406 using an implantable lead connector 400, according to someembodiments of the present invention.

Optionally, lead connector 400, IPG 408 and DDD-ICD 406 are similar tothat shown in FIG. 1 at 100, 108 and 106. Alternatively, lead connector400, IPG 408 and DDD-ICD 406 are similar to that shown in FIG. 2 at 200,208 and 206. Alternatively, lead connector 400, IPG 408 and DDD-ICD 406are similar to that shown in FIG. 3 at 300, 308 and 306. In leadconnector 100, switching “on” and “off” of the device ports is done, insome exemplary embodiments, using a current limiting circuit. In leadconnector 200, switching “on” and “off” of the device ports is done, insome exemplary embodiments, using serially connected voltage-dependentimpedance elements. In lead connector 300, switching “on” and “off” ofthe device ports is done, in some exemplary embodiments, using seriallyconnected voltage-dependent impedance elements and parallel connectedvoltage-dependent impedances.

In some exemplary embodiments, 2 leads are shared between IPG 408 andICD 406 through connector 400, reducing a number of cardiac leadsdelivered intravenously into the heart from 5 leads to 3 leads. Enteringconnector 400 from DDD-ICD 406 are 2 cables, a right atrial (RA) cable410A and a right ventricular (RV) cable 410B. Entering connector 400from IPG 408 for sharing are two cable, RA cable 412A and RV cable 412C.Optionally, a right ventricular septum lead (LS) 412B is routed throughconnector 400 to a different port (without sharing). Leading fromconnector 400 to a heart 416 are 3 cables, an RV cardiac lead 414A towhich is connected a shock electrode 410C from ICD 406, an RA cardiaclead 414C, and LS cardiac lead 414B.

Reference is now made to FIG. 5 which schematically illustrates anexemplary configuration for interconnecting an IPG 508 with a ICD-VVI506 using an implantable lead connector 500, according to someembodiments of the present invention. Optionally, lead connector 500,IPG 508 and DDD-ICD 506 are similar to that shown in FIG. 1 at 100, 108and 106. Optionally, lead connector 500, IPG 508 and DDD-ICD 506 aresimilar to that shown in FIG. 2 at 200, 208 and 206. Optionally, leadconnector 500, IPG 508 and DDD-ICD 506 are similar to that shown in FIG.3 at 300, 308 and 306. In lead connector 100, switching “on” and “off”of the device ports is done, in some exemplary embodiments, using acurrent limiting circuit. In lead connector 200, switching “on” and“off” of the device ports is done, in some exemplary embodiments, usingserially connected voltage-dependent impedance elements. In leadconnector 300, switching “on” and “off” of the device ports is done, insome exemplary embodiments, using serially connected voltage-dependentimpedance elements and parallel connected voltage-dependent impedances.

In some exemplary embodiments, 1 lead is shared between IPG 508 and ICD506 through connector 500, reducing a number of cardiac leads deliveredintravenously into the heart from 4 leads to 3 leads. Entering connector500 from ICD 506 is 1 cable, a right ventricular (RV) cable 510B.Entering connector 500 from IPG 508 for sharing is one cable, RV cable512C. Leading from connector 500 to a heart 516 is 1 cable, an RVcardiac lead 514A to which is connected a shock electrode 510C from ICD506. Optionally, leading directly from IPG 508 to heart 516 are 2cables, an RA cardiac lead 512A, and an LS cardiac lead 512B.

Reference is now made to FIG. 6 which schematically illustrates anexemplary configuration for interconnecting an IPG 608 with a DDD-ICD606 using an implantable lead connector 600, according to someembodiments of the present invention. Optionally, lead connector 600,IPG 608 and DDD-ICD 606 are similar to that shown in FIG. 1 at 100, 108and 106. Optionally, lead connector 600, IPG 608 and DDD-ICD 606 aresimilar to that shown in FIG. 2 at 200, 208 and 206. Optionally, leadconnector 600, IPG 608 and DDD-ICD 606 are similar to that shown in FIG.3 at 300, 308 and 306. In lead connector 100, switching “on” and “off”of the device ports is done, in some exemplary embodiments, using acurrent limiting circuit. In lead connector 200, switching “on” and“off” of the device ports is done, in some exemplary embodiments, usingserially connected voltage-dependent impedance elements. In leadconnector 300, switching “on” and “off” of the device ports is done, insome exemplary embodiments, using serially connected voltage-dependentimpedance elements and parallel connected voltage-dependent impedances.

In some exemplary embodiments, 2 leads are shared between IPG 608 andICD 606 through connector 600, reducing a number of cardiac leadsdelivered intravenously into the heart from 5 leads to 3 leads. Enteringconnector 600 from DDD-ICD 606 are 2 cables, a right atrial (RA) cable610A and a right ventricular (RV) cable 610B. Entering connector 600from IPG 608 for sharing are two cable, RA cable 612A and RV cable 612B.Leading from connector 600 to a heart 616 are 2 cables, an RV cardiaclead 614A to which is connected a shock electrode 610C from ICD 606 andan RA cardiac lead 614C. Optionally, leading directly from IPG 608 toheart 616 is 1 cable, an LS cardiac lead 612C.

Reference is now made to FIG. 7 which schematically illustrates anexemplary configuration for interconnecting an IPG 708 with an ICD-VVI706 using an implantable lead connector 700, according to someembodiments of the present invention. Optionally, lead connector 700,IPG 708 and ICD 706 are similar to that shown in FIG. 1 at 100, 108 and106. Optionally, lead connector 700, IPG 708 and ICD 706 are similar tothat shown in FIG. 2 at 200, 208 and 206. Optionally, lead connector700, IPG 708 and ICD 706 are similar to that shown in FIG. 3 at 300, 308and 306. In lead connector 100, switching “on” and “off” of the deviceports is done, in some exemplary embodiments, using a current limitingcircuit. In lead connector 200, switching “on” and “off” of the deviceports is done, in some exemplary embodiments, using serially connectedvoltage-dependent impedance elements. In lead connector 300, switching“on” and “off” of the device ports is done, in some exemplaryembodiments, using serially connected voltage-dependent impedanceelements and parallel connected voltage-dependent impedances.

In some exemplary embodiments, 2 leads are shared between IPG 708 andICD 706 through connector 700, reducing a number of cardiac leadsdelivered intravenously into the heart from 5 leads to 3 leads. Enteringconnector 700 from ICD 706 are 2 cables, a right atrial (RA) cable 710Aand a right ventricular (RV) cable 710B. Entering connector 700 from IPG708 for sharing are two cable, RA cable 712A and RV cable 712C.Optionally, a shock electrode 710C ICD 706 is routed through connector700 to a different port (without sharing). Leading from connector 700 toa heart 716 are 2 cables, an RV cardiac lead 714A to which is connectedshock electrode rerouted 710C, and an RA cardiac lead 714C. Optionally,leading directly from IPG 708 to heart 716 is 1 cable, an LS cardiaclead 712B.

Reference is now made to FIG. 8 which schematically illustrates anexemplary configuration for interconnecting an IPG 808 with an ICD-VVI806 using an implantable lead connector included in the IPG, accordingto some embodiments of the present invention. Optionally, the leadconnector, IPG 808 and ICD 806 are similar to that shown in FIG. 1 at100, 108 and 106. Optionally, the lead connector, IPG 808 and ICD 806are similar to that shown in FIG. 2 at 200, 208 and 206. Optionally, thelead connector, IPG 808 and ICD 806 are similar to that shown in FIG. 3at 300, 308 and 306. In lead connector 100, switching “on” and “off” ofthe device ports is done, in some exemplary embodiments, using a currentlimiting circuit. In lead connector 200, switching “on” and “off” of thedevice ports is done, in some exemplary embodiments, using seriallyconnected voltage-dependent impedance elements. In lead connector 300,switching “on” and “off” of the device ports is done, in some exemplaryembodiments, using serially connected voltage-dependent impedanceelements and parallel connected voltage-dependent impedances.

In some exemplary embodiments, ICD 806 is connected to the connector inIPG 808 through a DF-4 standard tetrapolar in-line connector cable 812C.Optionally, cable 812C includes in a single cable the RV cable and theshock electrode from ICD 806.

This type of connection allows for a number of cardiac leads deliveredintravenously into the heart to be reduced to 3. Leading from theconnector in IPG 808 to the heart are RA cable 812A, LS cable 812B, andRV cable 812D.

Reference is now made to FIG. 9 which illustrates a flow chart of anexemplary method of interconnecting an IPG with a DDD-ICD using animplantable lead connector, according to some embodiments of the presentinvention.

The exemplary method is described below with reference to the exemplaryconfiguration previously described and shown in FIG. 6 forinterconnecting multiple active implantable medical devices. It shouldbe evident to a person skilled in the art that numerous otherconfigurations for interconnecting a plurality of active implantablemedical devices are possible. Furthermore, it should be evident to theperson skilled in the art that the method described in not intended tobe necessarily limiting and may be practiced by the person skilled inthe art in numerous other ways, for example, by adding steps, removingsteps, skipping steps, or any combination thereof.

At 900, optionally a physician implants DDD-ICD 606 into a chest of apatient. Optionally, ICD 606 is implanted in a stomach pouch.Optionally, the patient is carrying an existent ICD 606 from a previousimplantation.

At 901, optionally the physician inserts IPG 608 into the patient'schest. Optionally, IPG 608 is an OPTIMIZER III IPG for CHF by ImpulseDynamics Ltd.

At 902, optionally the physician inserts implantable lead connector 600into the patient's chest and removably attaches the connector to ICD606. Optionally, connector 600 is removably attached to IPG 608, or isintegral with the IPG.

At 903, the physician connects RA cable 610A and RV cable 610B from ICD606 to ports RA1 and RV1 in connector 600, respectively.

At 904, the physician connects RA cable 612A and RV cable 612B from IPG608 to ports RA2 and RV2 in connector 600, respectively.

At 905, the physician connects an LS cardiac lead 612C from IPG 608 tothe right ventricular septum in the patient's heart.

At 906, optionally the physician connects an RV cardiac lead 614A and anRA cardiac lead 614C to ports RV3 and RA3 in connector 600,respectively. Optionally, the physician connects shock electrode 610Cfrom ICD 606 to RV cardiac lead 614A. Optionally, the physician insertsRV cardiac lead 614A into the right ventricle in the patient's heart.Optionally, the physician inserts RA cardiac lead 614C into the rightatrium of the patient's heart. Before or after implantation the IPGand/or ICD are optionally programmed to operate together, for example,by programming a blanking period into the IPG according to the ICD used.

Reference is made to FIG. 10 illustrates a flow chart of a method ofoperation of an implantable lead connector interconnecting an IPG and anICD including a pacemaker.

The exemplary method is described below with reference to the exemplaryconfiguration previously described and shown in FIG. 9 forinterconnecting multiple active implantable medical devices. It shouldbe evident to a person skilled in the art that numerous otherconfigurations for interconnecting a plurality of active implantablemedical devices are possible. Furthermore, it should be evident to theperson skilled in the art that the method described, as applies to theoperation of the implantable lead connector, is not intended to benecessarily limiting and may be practiced by the person skilled in theart in numerous other ways, for example, by adding steps, removingsteps, skipping steps, or any combination thereof.

At 1000, RV cardiac lead 614A and RA cardiac lead 614C sensephysiological signals in the patient's heart. The RA signals and RVsignals are transferred through connector 600 to ICD 606 and IPG 608.Optionally, the physiological signal is sensed by only one of thedevices, and is picked up from the first device by the second device forexample, IPG 606 from ICD 608. The port impedances in connector 600 arelow. Optionally, only the port impedance of the device receiving thephysiological signal is low, the port impedance of the second device ishigh. Optionally, controller 600 decides which device will sense thephysiological signal. Optionally, controller 600 decides which devicewill analyze the signal. Optionally, the decision is based on apredetermined criteria preprogrammed into the connector.

At 1001, abnormal physiological signals are sensed by ICD 606.Optionally, the physiological signals are sensed by IPG 608. An analysisof the abnormal signals is made by ICD 606 for determining whether astimulation signal is required for pacing or defibrillation. If an ICDgenerated stimulation signal is required continue to 1002. If theabnormal signals are not associated with a pacing or defibrillationproblem, continue to 1006.

At 1002, optionally ICD 606 generates a stimulation signal.

At 1003, optionally connector 600, responsive to the detection of thestimulation signal from ICD 606, adjusts the impedances at ports RV2 andRA2 to high, essentially switching “off” IPG 608. Impedances at portsRA1 and RV1 are low so that ICD 606 is switched “on”.

At 1004, optionally a defibrillation stimulation signal from ICD 606flows through shock electrode 610C to RV cardiac lead 614A. Optionally,a pacing stimulation signal from ICD 606 flows through RA cable 610A andRV cable 610B into connector 600 and flow out the connector to heart 616through RV cardiac lead 614A RA cardiac lead 614C.

At 1005, optionally heart returns to normal functioning. Return to 1000for continuing to monitor the normally functioning heart.

At 1006, optionally, an analysis of the abnormal signals is made by IPG608 for determining whether a stimulation signal is required for CHF. Ifan IPG generated stimulation signal is required continue to 1007. If theabnormal signals are not associated with a CHF problem, continue to1011.

At 1007, optionally IPG 608 generates a stimulation signal.

At 1008, optionally connector 600, responsive to the detection of thestimulation signal from IPG 608, adjusts the impedances at ports RV1 andRA1 connecting to ICD 606 to high. Optionally, ICD 606 is essentiallycut off from the circuit. Impedances at ports RA2 and RV2 in connector600 connecting to IPG 608 are low.

At 1009, optionally a stimulation signal from IPG 608 flows through LScardiac lead 612C to heart 616. Optionally, the stimulation signal fromIPG 608 flows through RA cable 612A and RV cable 612B into connector 600and flow out the connector to heart 616 through RV cardiac lead 614A andRA cardiac lead 614C.

At 1010, optionally heart returns to normal functioning. Return to 1000for continuing to monitor the normally functioning heart.

At 1011, optionally seek urgent medical attention if the patient doesnot feel well.

Reference is now made to FIGS. 11A-11C which schematically illustrate acombined IPG/ICD device 1100 including an attachable lead connector1103, according to some embodiments of the present invention. In anexemplary embodiment of the invention, the interconnection circuitrydescribed above is integrated with IPG device 1100 and element 1103serves only to connect the ICD to the IPG. Optionally, connector 1103 isprovided in kit form, optionally packaged with the IPG and/or indifferent sizes/designs for different ICD, for connecting an ICD to theintegrated IPG/connection circuitry.

In an exemplary embodiment, IPG/ICD device 1100 comprises an assemblyfitting together three removably attachable units IPG 1101, ICD 1102 andthe lead connector 1103, or a plain connector 1103, if, for example, theconnection circuitry is integrated with the IPG. Optionally, IPG 1101 isconnected to connector 1103 through a DF-4 standard in-line tetrapolarconnector 1104, which is optionally integral with 1103. ICD is connectedto connector 1103 through an RV (right ventricular) IS-1 type connector1105 and through an RA (right atrium) IS-1 type connector 1106, each ofwhich are optionally integral with connector 1103 so that all ICD leadsare shared with IPG 1101 through the connector. Single leads forconnecting to a heart 1116 are optionally connected to the IPG ports,and include an RA lead 1110, a CCM lead 1111, an RV lead 112 to which isconnected a shock lead 1113, and an optional LV (left ventricular) lead1114.

Optionally the IPG and ICD are attached together. Optionally, theconnector 1103 provides mechanical attachment, for example, using a bagor net (not shown), or an adhesive layer.

In some exemplary embodiments, lead connector 1103, IPG 1101 and ICD1102 are similar to that shown in FIG. 1 at 100, 108 and 106, orreference 100 is integrated into IPG 1101. In another embodiment, leadconnector 1103, IPG 1101 and ICD 1102 are similar to that shown in FIG.2 at 200, 208 and 206, or reference 200 is integrated into IPG 1101. Inanother embodiment, lead connector 1103, IPG 1101 and ICD 1102 aresimilar to that shown in FIG. 3 at 300, 308 and 306, or reference 300 isintegrated into IPG 1101. In lead connector 100, switching “on” and“off” of the device ports is done, in some exemplary embodiments, usinga current limiting circuit. In lead connector 200, switching “on” and“off” of the device ports is done, in some exemplary embodiments, usingserially connected voltage-dependent impedance elements. In leadconnector 300, switching “on” and “off” of the device ports is done, insome exemplary embodiments, using serially connected voltage-dependentimpedance elements and parallel connected voltage-dependent impedances.

FIG. 12 shows an exemplary timing diagram. Typically, when a device usesthe same electrode in order to sense tissue electrical activity (forexample, in the range of mili-Volts) it includes very sensitive senseamplifiers at the front-end connection to the electrode. When the devicestimulates the muscle, it applies signals in the range of Volts. If thesame electrode is used both for sensing and for signal delivery, then ablanking period may be used in which the device disconnects the senseamplifier from the electrodes while stimulation signal is delivered. Ifthe delivered signal is relatively strong, a balancing phase isoptionally added after the signal has been delivered in order to reducethe polarization of the electrode (due to the delivered signal) beforereconnecting the sense amplifiers.

Optionally usage of a blanking period allows the same electrode to havemultiple uses, provided that these are time separated.

Referring back to FIG. 12, the atrial sensing is operating, and if anatrial pacing is delivered, a blanking period applies to the atrialsense amplifier of the pacemaker. Similarly, following the activation ofthe ventricles a blanking period can be applied to the ventricular senseamplifier (if one or more of the ventricles was paced, or even if it wasonly a natural ventricular activity which was sensed).

Optionally, when two stimulation devices are connected to the sameelectrode, a similar logic can be applied if the timing of events do notoverlap, and if the sense amplifiers of one device can be either blankedor tolerate the signal when the other device delivers its signal.

In an exemplary embodiment of the invention, the non-excitatory signal(CCM) can be delivered during the absolute refractory period, in a timewhen the sense amplifiers of the pacemaker (or ICD) can be blanked(e.g., by the devices or by the connector described herein). In anexemplary embodiment of the present invention a standard pacemaker or anICD can be used without modification, and optionally programmed to havethe blanking period long enough during the refractory period such as toavoid interference from the CCM signal.

In an exemplary embodiment of the invention, when the pacemaker appliesa pacing signal, the sense amplifiers of the CCM delivery device areoptionally blanked (e.g., if a preceding indication of pacing isobtained or using the above described connector), or designed totolerate it. Optionally, such toleration can be either by the circuitryof the CCM delivery device, or by a circuitry in the lead connector thatis connected to both devices and to the lead, and which may block mostof the applied voltage.

The following patents and patent applications describe devices andmethods which may be used for electrical stimulation and control, forexample, as described herein and coupled to a connector or integral withinterconnection circuitry. The following patents and applications areincorporated herein by reference in their entirety.

U.S. Pat. Nos. 6,317,631; 6,363,279; 6,330,476; 7,062,318; 7,167,748;6,233,484; 6,236,887; 6,415,178; 7,218,963; 6,298,268; 6,463,324;7,412,289; 7,460,907; 6,292,693; 6,675,043; 6,725,093; 7,310,555;6,587,721; 6,442,424; 6,304,777; 6,285,906; 6,662,055; 6,522,904;6,254,610; 6,152,882; 6,360,126; 6,223,072; 6,459,928; 6,233,487;6,597,952; 6,360,123; 6,263,242; 6,424,866; 6,370,430; 6,292,704;7,190,997; 7,171,263; 7,092,753; 6,348,045; 6,335,538; 6,529,778;7,187,970; 6,993,385; 7,647,102; 7,027,863; 6,480,737; 6,602,183;6,973,347; 6,749,600; 7,195,637; 6,571,127; 7,221,978; 6,947,792;7,120,497; 7,006,871; 6,600,953; 6,993,391; 7,512,442; 7,437,195;7,330,753; 7,502,649;Ser. Nos. 10/039,845; 11/550,560; 11/931,724; 11/931,889; 11/932,064;11/932,149; 11/933,168; 09/980,748; 10/116,201; 11/673,812; 10/111,512;11/247,736; 10/549,216; 12/155,448; 11/792,811; 11/919,491; 11/802,685;11/991,481; 12/223,651; 11/736,183; 11/932,881; 11/932,812; 11/932,963;11/318,845; 10/237,263; 10/526,708; 10/804,560; 10/570,576; 11/848,555;11/573,722; 11/336,099; 10/599,015; 11/884,389; 11/816,574; 12/160616;11/566,775; 11/551,282; 12/010,396.

Examples

Reference is now made to the following examples, which together with theabove descriptions, illustrate some embodiments of the invention in anon limiting fashion.

In an exemplary embodiment of the invention, the interconnectioncircuitry is integrated with an IPG (such as a contractility modulationdevice, for example as describe din some of the above patents andapplications). In one example, the circuitry is provided inside thecasing of the IPG. In another example, the IPG includes a connectorblock and this block (e.g., of injected plastic) includes bothconnectors for attachment to an ICD or other device, such as pacemakeror combined CRT-ICD and connector(s) for one or more lead to the heart.Optionally the circuitry is also located within the connector block. Inan exemplary embodiment of the invention the IPG and the interconnectioncircuitry are provided to a user for implantation as a monolithicinseparable device, in a sterile packaging, optionally with no spacebetween the IPG and circuitry for bacterial growth. Optionally anyintegration is at a factory.

Optionally or alternatively, the interconnection circuitry is coupledusing a rigid coupling or adhesive to the IPG. In another embodiment,the connection circuitry is coupled with a lead to the heart and/orleads suitable for connection to stimulator devices.

In an exemplary embodiment of the invention, the connector includes reedswitches, dip switches or other configurations means which adapt theport mapping between inputs and outputs to match various configurationof attached devices. Optionally or alternatively configuration isdetermined by attachment to particular ports of the connector.Optionally unused ports are plugged. Optionally suitable plugs areprovided with a kit of the IPG and/or connector. Optionally such a kitincludes a rigid connector for interconnecting an ICD (or other device)and the IPG. Optionally such rigid connector also provides electricalconnection. Optionally or alternatively, configuration is by attachingshorting sections between ports on the lead connector.

In an exemplary embodiment of the invention the connector includes twosets of inputs, each of between 1 and 4 inputs. In some cases, theinputs share a single cable connection. In another example, one or moresplitters or combiners are used to match an existing lead cable to thelead connector.

In an exemplary embodiment of the invention the connector includesenough ports to accommodate all connections to/from the devices.Optionally or alternatively a plurality of connectors may be used.Optionally one connector can be a slave of another connector in that itsinternal impedance can be linked to a voltage on the other connector,for example, by electrical connection. In another example, a singlemonolithic connector is replaced by a plurality of connectors which areattached to each other by electrically conducting cables. Optionally oralternatively one or more isolators are provided as separate elements,for example, as a isolator device with two connections to a cable and asensing cable terminating in a sensing element that is mounted on a lead(e.g., a coil sensor), whose sensing is used to control an isolationprovided by the isolator. Optionally or alternatively the connector isflexible/bendable.

While in exemplary embodiments of the invention the integrationcircuitry isolates the IPG from the ICD (or other devices), in someembodiments, at least one of the devices or sensor inputs thereof isdesigned to withstand high voltages in sensor inputs rather than beisolated. Optionally, the interconnection circuitry comprises a shortcircuit or other fixed impedance connection between two or more inputs.

In an exemplary embodiment of the invention a coil sensor is used toallow an IPG to “sense” an impulse generated by a pacemaker or ICD.Optionally the coil is and/or an impedance matcher coupled thereto areconfigured so that the sensor input level is as expected. Optionally theconnector generates one or more signals which emulate normal or abnormalbeating of a heart, to feed faxed sensed signals into one of thedevices.

In an exemplary embodiment of the invention, the connection circuitdraws power from an IPG battery, for example, if they share a samecasing or mechanical structure.

In should be noted that a feature of some embodiments of the inventionis that an IPG circuitry need not be redesigned to work with a differentstimulator. Optionally even a logic thereof is not changed and tested.Optionally some programming, such as changing blanking periods may beuseful, but can be within normal ranges.

In should be noted that a feature of some embodiments of the inventionis that all standard connectors remain as before. In particular, thecable connections to the ICD and/or connector of the cardiac lead canremain as before. Optionally the lead connector has a female socket tomatch the male plug of the cardiac lead and/or two male plugs to receiveleads from the ICD. In an alternative embodiment, all ports are femaleand a special connector, using standard connector design, is used tocouple the devices. Optionally or alternatively the connector includesintegral leads to connect to the devices.

Following are some exemplary uses of and/or usage parameters for theabove described pulse generators and connectors for treating heart orother organs, in accordance with exemplary embodiments of the invention.

In an exemplary embodiment of the invention, an electric field (e.g.,energy) is delivered to a tissue during the refractory period of thetissue (or adjacent/related tissue) to affect tissue behavior. In anexemplary embodiment of the invention the electric field is delivered toa tissue to affect one or more of contraction force, structure,function, metabolism, secretion, biochemical process, gene expression,protein expression and/or protein phosphorylation of that tissue.Optionally the electric field is delivered to a tissue during therefractory period of the tissue to affect one or more of contractionforce, metabolism, secretion, biochemical process, gene expression,protein expression, and protein phosphorylation of that tissue.

In some embodiments, the electric field is formed as an extended pacingpulse, having energy extended into the refractory period being suitableto obtain the desired effect.

In an exemplary embodiment of the invention, the electric field isdelivered in response to detection of activity of the tissue. Optionallythe detected activity is a sensed electrical activity. Optionally oralternatively the detected activity is a sensed mechanical activity.Optionally or alternatively the field is applied immediately in responseto the detected activity. Optionally or alternatively the field isapplied at a delay from the detected activity, for example, at least 5msec, 10 msec, 20 msec, 30 msec, 50 msec, 70 msec, 100 msec, orintermediate values and/or less than 150 msec (milliseconds).

In an exemplary embodiment of the invention the electric field isapplied in response to indication that a pacing signal has beendelivered to the tissue. Optionally the indication is received from apacemaker. Optionally or alternatively the indication is obtained bysensing an electrical artifact generated by the pacing signal.Optionally or alternatively the indication is obtained by directconnectivity of the field generator to the pacing generator. Optionallyor alternatively the field is applied to extend from (e.g., incontinuation to) the pacing signal (e.g., immediately in response to thepacing indication). Optionally or alternatively the field is applied ata delay from an indication of pacing, of, for example, at least 5 msec,10 msec, 20 msec, 30 msec, 50 msec, 70 msec, 100 msec or intermediatevalues and/or less than 150 msec.

In an exemplary embodiment of the invention the electric field comprisesat least one monophasic field applied during the refractory period.Optionally the at least one monophasic field is alternating among heartbeats between a negative field and a positive field. Optionally oralternatively the alternating occurs every few heart beats. Optionallyor alternatively the alternating occurs after every heart beat.Optionally or alternatively the at least monophasic field has a trailingbalancing phase to reduce charge accumulation on the electrode (reducepolarization). Optionally the balancing phase has an opposite polarityof that of the field with substantially smaller amplitude. Optionally oralternatively the balancing phase has a substantially zero amplitude.

In an exemplary embodiment of the invention the at least one monophasicfield has a duration of at least 5 msec, 10 msec, 20 msec, 30 msec, 50msec in each heart beat. Optionally or alternatively the at least onemonophasic field has a duration which is not greater than 100 msec, 150msec in each heart beat.

In an exemplary embodiment of the invention the field comprises a trainof monophasic pulses. Optionally the overall length of the train fromthe beginning of the first pulse to the end of the last pulse is at ofat least 5 msec, 10 msec, 20 msec, 30 msec, 50 msec or intermediatevalues in each heart beat. Optionally or alternatively the overalllength of the train from the beginning of the first pulse to the end ofthe last pulse is not greater than 100 msec, 150 msec or intermediatevalues in each heart beat. Optionally or alternatively cumulative lengthof the monophasic pulses in the train is at of at least 5 msec, 10 msec,20 msec, 30 msec, 50 msec or intermediate values in each heart beat.Optionally or alternatively, the cumulative length of the monophasicpulses in the train is not greater than 100 msec, 150 msec orintermediate values in each heart beat. Optionally or alternatively theduration of each pulse of the pulse train is at least 0.5 msec, 1 msec,2 msec, 4 msec, 8 msec or intermediate values. Optionally oralternatively, the cumulative number of monophasic pulses in the trainis at least 2, 3, 5, 8, 10, 15, 20, 25, 35, 50, or intermediate valuesin each heart beat. Optionally or alternatively, the cumulative numberof monophasic pulses in the train is no greater than 100 in each heartbeat. Optionally or alternatively the delay between consecutivemonophasic pulsed is at least 0, 0.5 msec, 1 msec, 2 msec, 5 msec, 10msec, 15 msec or intermediate values.

In an exemplary embodiment of the invention the electric field comprisesat least one biphasic field applied during the refractory period.Optionally the at least one biphasic field starts with a positive phase.Alternatively, the at least one biphasic field starts with a negativephase. Optionally or alternatively the at least one biphasic field hassymmetry between the positive and negative phases. Alternatively, the atleast one biphasic field has asymmetry between the positive and negativephases. Optionally one phase has an amplitude of at least 10% greaterthan the other phase. Optionally or alternatively one phase has aduration of at least 10% greater than the other phase.

In an exemplary embodiment of the invention the at least one biphasicfield has a time delay between the first phase and the second phase.Optionally the time delay is of at least 0.5 msec, 1 msec, 2 msec orintermediate values. Optionally or alternatively the at least onebiphasic field is alternating between a start positive field and a startnegative field. Optionally or alternatively the at least one biphasicfield has a trailing balancing phase to reduce charge accumulation onthe electrode (e.g., to reduce polarization). Optionally the balancingphase has an opposite polarity of that of the last phase of the fieldwith substantially smaller amplitude. Optionally the balancing phase hasa substantially zero amplitude.

Optionally the at least one biphasic field has a duration of at least 3msec, 5 msec, 10 msec, 20 msec, 30 msec, 50 msec or intermediate values,in each heart beat. Optionally or alternatively the at least onebiphasic field has a duration which is not greater than 100 msec, 150msec or intermediate values, in each heart beat.

Optionally the field comprises a train of biphasic pulses. Optionallythe overall length of the train from the beginning of the first pulse tothe end of the last pulse is at of at least 5 msec, 10 msec, 20 msec, 30msec, 50 msec or intermediate values, in each heart beat. Optionally oralternatively the overall length of the train from the beginning of thefirst pulse to the end of the last pulse is not greater than 100 msec,150 msec or intermediate values, in each heart beat. Optionally oralternatively the cumulative length of the biphasic pulses in the trainis at of at least about 5 msec, 10 msec, 20 msec, 30 msec, 50 msec orintermediate values, in each heart beat. Optionally or alternatively,the cumulative length of the biphasic pulses in the train is not greaterthan 100 msec, 150 msec or intermediate values, in each heart beat.Optionally or alternatively the duration of each phase of the pulsetrain is at least about 0.5 msec, 1 msec, 2 msec, 4 msec, 5.5 msec, 8msec, or intermediate values. Optionally or alternatively the cumulativenumber of biphasic pulses in the train is at least 2, 3, 5, 8, 10, 15,20, 25, 35, 50 or intermediate values, in each heart beat. Optionally,the cumulative number of biphasic pulses in the train is no greater than100 in each heart beat. Optionally or alternatively the delay betweenconsecutive biphasic pulsed is at least 0, 0.5 msec, 1 msec, 2 msec, 5msec, 10 msec, 15 msec or intermediate values.

In an exemplary embodiment of the invention the electric field comprisesat least one biphasic field and at least one monophasic field appliedduring the refractory period.

In an exemplary embodiment of the invention the electric field comprisesat least 2 pulses.

In an exemplary embodiment of the invention the electric field isapplied concurrently through multiple electrodes.

In an exemplary embodiment of the invention, the electric field isapplied through multiple electrodes wherein at least one of theelectrodes delivers a subset of the pulses and at least another one ofthe electrodes delivers another subset of the pulses.

In an exemplary embodiment of the invention the electric field isapplied through multiple electrodes wherein at least one of theelectrodes delivers one part of the field and at least another one ofthe electrodes delivers a second part of the field. Optionally, one partof the field and second part of the field are not identical. Optionallyor alternatively one part of the field and said second part of the fieldcomprise different time fragments of the electric field.

In an exemplary embodiment of the invention, the electric fielddelivered in each heart beat has a total energy which is at least 5times greater than that which is sufficient for obtaining pacing in thatheart through the electrodes. Optionally the electric field delivered ineach heart beat has a total energy which is at least 10 times greaterthan that which is sufficient for obtaining pacing in that heart throughthe electrodes. Optionally the electric field delivered in each heartbeat has a total energy which is at least 30 times greater than thatwhich is sufficient for obtaining pacing in that heart through theelectrodes. Optionally the electric field delivered in each heart beathas a total energy which is at least 50 times greater than that which issufficient for obtaining pacing in that heart through the electrodes.

Optionally the electric field delivered in each heart beat has a totalenergy which is not greater 1 Joule. Optionally the electric fielddelivered in each heart beat has a total energy which is not greater 50mili-Joule. Optionally the electric field delivered in each heart beathas a total energy which is not greater 10 mili-Joule.

In an exemplary embodiment of the invention the amplitude of the fieldis between 2 Volts and 20 Volts. Optionally, the amplitude is between 3Volts and 12 Volts.

In an exemplary embodiment of the invention, the electric field ischronically delivered through implantable electrodes for long termtreatment. Optionally the electric field is applied through coatedelectrodes having resistance between 100 Ohm and 3000 Ohm and cumulativesurface area of at least 2 mm̂2. Optionally, the electric field isapplied through coated electrodes having resistance between 250 Ohm and2000 Ohm and cumulative surface area of at least 3 mm̂2.

Optionally or alternatively the electric field is applied throughelectrodes having a coating by at least one of a fractal coating,iridium-oxide, titanium-nitride.

In an exemplary embodiment of the invention the electrodes are connectedto a smooth muscle. Optionally the field is chronically applied throughimplantable electrodes. Optionally or alternatively the chronicapplication of the field is used to treat a disease (e.g., one ofmetabolic, hypertension, obesity, diabetes, gi-tract motility).

In an exemplary embodiment of the invention the electric field isapplied to the heart (e.g., using electrodes connected to the heart).Optionally the chronic delivery of the electric field treats heartfailure. Optionally or alternatively, the chronic delivery of theelectric field elevates force of contraction. Optionally oralternatively, the chronic delivery of the electric field improvescardiac output. Optionally or alternatively, the chronic delivery of theelectric field improves cardiac stroke volume. Optionally oralternatively, the chronic delivery of the electric filed improvescardiac ejection fraction. Optionally or alternatively the chronicdelivery of the electric field improves patient heart-related clinicalcondition. Optionally or alternatively, the chronic delivery of theelectric field promotes reverse remodeling of the diseased heart.Optionally or alternatively the chronic delivery of the electric fieldnormalizes gene expression in the tissue of genes associated with thedisease. Optionally or alternatively the chronic delivery of theelectric field normalizes protein expression in the tissue of proteinsassociated with the disease. Optionally or alternatively the chronicdelivery of the electric field improves protein function in the tissueof proteins associated with the disease. Optionally or alternatively,the electric field is applied at least to the right ventricle, leftventricle, the ventricular septum, or combination thereof. Optionallyelectric field is applied to at least 2 locations in the heart.Optionally or alternatively the electric field is applied throughendocardial electrodes, epicardial electrodes, trans-venous electrodesor combinations thereof.

In an exemplary embodiment of the invention, the electric field isapplied on demand. Optionally, the electric field is applied on demandbased on a patient input. Optionally or alternatively the electric fieldis applied on demand based on a physiological input associated withstress. Optionally or alternatively the electric field is applied ondemand based on a physiological input associated with rest.

In an exemplary embodiment of the invention the electric field isapplied in accordance with a logic circuitry configured to determinethat the electrical conduction of a heart beat is of at least one of(and/or which one it is): a normally conducting beat, a paced beat, anabnormal conducting beat, is a normal ventricular conduction, is aabnormal ventricular conduction, is a ventricular ectopic activity.Optionally the logic circuitry is configured to minimize electric fielddelivery in substantially abnormal ventricular conduction beats.Optionally or alternatively the logic circuitry is configured to avoidelectric field delivery in abnormal ventricular conduction beats.Optionally or alternatively the logic circuitry is configured to adjust(or select from some sets of) at least one of the parameters of thefield delivery selected from a group comprising amplitude, timing, delayduration, shape of the field, in accordance with said determining.Optionally or alternatively the logic circuitry determines the type ofelectrical conduction by receiving indication from a pacemaker and/ordefibrillator. Optionally or alternatively, the logic circuitrydetermines the type of electrical conduction by sensing the electricalactivity of the tissue. Optionally or alternatively, logic circuitrydetermines the type of electrical conduction by analyzing at least oneof the timing and morphology of the local electrical activity as sensedby at least one implantable electrode. Optionally or alternatively, thelogic circuitry determines the type of electrical conduction byanalyzing at least one of the timing and morphology of the globalelectrical activity as sensed between an implantable electrode and thecan of the implantable pulse generator.

In an exemplary embodiment of the invention the electric field isapplied to at least 5% of the heart beats of a week. Optionally electricfield is applied to at least 5% of the heart beats of a day. Optionally,the electric field is applied to at least 10% of the heart beats of aday. Optionally or alternatively, the electric field is appliedintermittently over a period of several hours per day. Optionally oralternatively, electric field is applied during several hours of a dayin accordance with a programmed schedule.

In an exemplary embodiment of the invention the electric field isdelivered through at least some of the electrodes that have at least oneother use. Optionally the electric field is delivered through at leastsome of the electrodes through which a sensing circuitry senseselectrical activity of the tissue. Optionally or alternatively theelectric field is delivered through at least some of the electrodesthrough which a pacemaker or a defibrillator senses electrical activityof the tissue. Optionally or alternatively the electric field isdelivered through at least some of the electrodes through which apacemaker or a defibrillator deliver pacing and/or defibrillatingsignals. Optionally or alternatively electrodes used for the delivery ofthe field are bipolar. Optionally or alternatively the connection of theelectrodes to the electric field generator device and to the pacemakeror defibrillator device has a protection electrical circuitry thatprevents the delivery of signals from one device to adversely interferewith the sensing circuitry of the other device.

The terms “comprises”, “comprising”, “includes”, “including”, “having”and their conjugates mean “including but not limited to”. This termencompasses the terms “consisting of” and “consisting essentially of”.

The phrase “consisting essentially of” means that the composition ormethod may include additional ingredients and/or steps, but only if theadditional ingredients and/or steps do not materially alter the basicand novel characteristics of the claimed composition or method.

As used herein, the singular form “a”, “an” and “the” include pluralreferences unless the context clearly dictates otherwise. For example,the term “a compound” or “at least one compound” may include a pluralityof compounds, including mixtures thereof.

The word “exemplary” is used herein to mean “serving as an example,instance or illustration”. Any embodiment described as “exemplary” isnot necessarily to be construed as preferred or advantageous over otherembodiments and/or to exclude the incorporation of features from otherembodiments.

The word “optionally” is used herein to mean “is provided in someembodiments and not provided in other embodiments”. Any particularembodiment of the invention may include a plurality of “optional”features unless such features conflict.

Throughout this application, various embodiments of this invention maybe presented in a range format. It should be understood that thedescription in range format is merely for convenience and brevity andshould not be construed as an inflexible limitation on the scope of theinvention. Accordingly, the description of a range should be consideredto have specifically disclosed all the possible subranges as well asindividual numerical values within that range. For example, descriptionof a range such as from 1 to 6 should be considered to have specificallydisclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numberswithin that range, for example, 1, 2, 3, 4, 5, and 6. This appliesregardless of the breadth of the range.

Whenever a numerical range is indicated herein, it is meant to includeany cited numeral (fractional or integral) within the indicated range.The phrases “ranging/ranges between” a first indicate number and asecond indicate number and “ranging/ranges from” a first indicate number“to” a second indicate number are used herein interchangeably and aremeant to include the first and second indicated numbers and all thefractional and integral numerals therebetween.

As used herein the term “method” refers to manners, means, techniquesand procedures for accomplishing a given task including, but not limitedto, those manners, means, techniques and procedures either known to, orreadily developed from known manners, means, techniques and proceduresby practitioners of the chemical, pharmacological, biological,biochemical and medical arts.

It is appreciated that certain features of the invention, which are, forclarity, described in the context of separate embodiments, may also beprovided in combination in a single embodiment. Conversely, variousfeatures of the invention, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable subcombination or as suitable in any other describedembodiment of the invention. Certain features described in the contextof various embodiments are not to be considered essential features ofthose embodiments, unless the embodiment is inoperative without thoseelements.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims.

All publications, patents and patent applications mentioned in thisspecification are herein incorporated in their entirety by referenceinto the specification, to the same extent as if each individualpublication, patent or patent application was specifically andindividually indicated to be incorporated herein by reference. Inaddition, citation or identification of any reference in thisapplication shall not be construed as an admission that such referenceis available as prior art to the present invention. To the extent thatsection headings are used, they should not be construed as necessarilylimiting.

What is claimed is:
 1. A system, comprising: a first implantable device;a second implantable device; and interconnecting circuitry electricallyconnecting said first and second implantable devices; wherein saidsystem is configured to allow power sharing between at least two of saidfirst and second implantable devices and said interconnecting circuitry.2. A system according to claim 1, further including at least one leadconnector, wherein said system is configured to allow power sharingbetween said lead connector and at least one of said first and secondimplantable devices.
 3. A system according to claim 2, wherein said atleast one lead connector is configured to allow one of said first andsecond implantable devices to be powered by another one of said firstand second implantable devices.
 4. A system according to claim 3,further including at least a third implantable device, wherein said atleast one lead connector is configured to allow one of said implantabledevices to power the other ones of said implantable devices.
 5. A systemaccording to claim 2, wherein said at least one lead connector isconfigured to power at least one of said first and second implantabledevices.
 6. A system according to claim 2, further including at least athird implantable device, wherein said at least one lead connector isconfigured to power each of said implantable devices.
 7. A systemaccording to claim 2, wherein said at least one lead connector includesa power supply configured for powering said first and second implantabledevices.
 8. A system according to claim 2, wherein said at least onelead connector includes a power supply configured for powering first andsecond implantable circuitry connected to said first and secondimplantable devices, respectively.
 9. A system according to claim 1,wherein said power supply includes a battery.
 10. A system according toclaim 9, wherein said battery is rechargeable.
 11. A system according toclaim 9, further comprising a power harvester circuit configured forcharging said battery.
 12. A system according to claim 11, wherein saidpower harvester circuit is configured to harvest power from at least oneof a body in which at least one of said first and second implantabledevices is implanted, a power transmitter external to the body, andstimulation signals transmitted to the body by at least one of saidimplantable devices.
 13. A system according to claim 12, furthercomprising a power storage element configured for storing powerharvested from the body.
 14. The system of claim 1, wherein each of saidfirst and second implantable devices is selected from a cardiacpacemaker, a defibrillator, a pacing defibrillator, and an implantablepulse generator (IPG) for CCM (Cardiac Contractility Modulation).
 15. Asystem, comprising: a housing containing a first implantable deviceincluding a CCM (Cardiac Contractility Modulation) device and a secondimplantable device selected from at least one of a pacemaker and adefibrillator; and interconnecting circuitry electrically connectingsaid first and second implantable devices; wherein said system isconfigured to allow power sharing between at least two of said first andsecond implantable devices and said interconnecting circuitry.
 16. Asystem, comprising: a first implantable device having a power supply; asecond implantable device; and interconnecting circuitry which allowspower to be shared between at least two of said first and said secondimplantable devices and said interconnecting circuitry.
 17. A systemaccording to claim 16, wherein said interconnecting circuitry comprisesa battery to be used for said power sharing.
 18. A system according toclaim 16, wherein said interconnecting circuitry is powered by at leastone of said first and second implantable devices.
 19. A system accordingto claim 16, wherein said interconnecting circuitry selectively usespower from one of said power supply of said first implantable device anda power supply from said second implantable device.
 20. A systemaccording to claim 16, wherein at least one of said first and secondimplantable devices includes a resource configured to be shared by saidat least one lead connector.
 21. A system, comprising: a firstimplantable device; a second implantable device; and at least one leadconnector configured to connect at least one of said first and secondimplantable devices to a target tissue or organ; wherein at least oneof: at least one of said first and second implantable devices includes aresource configured to be shared with said at least one lead connector;and said at least one lead connector includes a resource configured tobe shared with at least one of said first and second implantabledevices.
 22. The system of claim 21, wherein said resource is at leastone of a controller, a memory, a single lead, a power source, and logiccircuitry.
 23. The system of to claim 21, wherein said at least one leadconnector is removably attachable to at least one of said first andsecond implantable devices and is configured to share resources of saidat least one of said first and second implantable devices.
 24. Thesystem of claim 21, wherein said at least one lead connector isconfigured to physically interface said first and second implantabledevices.
 25. A system according to claim 21, wherein said at least onelead connector is configured to allow power sharing between said firstand second implantable devices.
 26. A system according to claim 21,further comprising circuitry in said second implantable deviceconfigured to at least one of sense operational commands of said firstimplantable device and estimate a state of tissue due to operation ofsaid first implantable device.
 27. A system according to claim 26,wherein said second implantable device is configured to delay itsoperation based on at least one of said sensed operational commands andsaid estimated tissue state.
 28. The system of claim 21, wherein each ofsaid first and second implantable devices is selected from a cardiacpacemaker, a defibrillator, a pacing defibrillator, and an implantablepulse generator (IPG) for CCM (Cardiac Contractility Modulation).
 29. Asystem, comprising: at least one implantable device; and at least onelead connector configured to connect said at least one implantabledevice to a target tissue or organ; wherein said at least one leadconnector is configured to update a functionality of said at least oneimplantable device.
 30. The system of claim 29, wherein said at leastone lead connector is configured to add a functionality provided by oneof said at least one lead connector to at least one of said at least oneimplantable device.
 31. The system of claim 30, wherein said addedfunctionality includes at least one of advanced pacing logic and anadditional pacemaker function.
 32. The system of claim 30, wherein saidadded functionality includes implantable cardiac defibrillators (ICD).33. The system of claim 30, wherein said at least one lead connector isconfigured to at least one of: add blanking periods to protect said atleast one implantable device from another implantable device;synchronize functions of said at least one implantable device with atleast another implantable device; delay operation of a second of saidimplantable devices after the operation of a first implantable device;act as a switch for signal flow between said at least one implantabledevice and at least another implantable device to and from a targettissue or organ; switch off a first said implantable device and listento a second implantable device of said system and switch on said firstimplantable device when required; allow a first implantable device tolisten to a second implantable device of said system; allow oneimplantable device to use information related to pacing in a first modehaving a first set of parameters to change to a second mode having asecond set of parameters different from said first set of parameters;allow one implantable device to use the information to change windowssettings; and switch between at least one sensing input and one firstsignal output for sensing and stimulating two different tissues atdifferent times.
 34. The system of claim 29, wherein said implantabledevice is selected from a cardiac pacemaker, a defibrillator, a pacingdefibrillator, and an implantable pulse generator (IPG) for CCM (CardiacContractility Modulation).